What It Means to Declare COVID Misinformation a Health Crisis

San Diego County, Calif., declared COVID-19 misinformation a public health crisis last August. This initiative, which was inspired by advice from the U.S. surgeon general, has focused on sending out accurate information and addressing untruths. The county also doesn’t penalize anyone for spreading misinformation.

Six months later, is the strategy working? And should other counties follow suit?

Spreading the Good

Health misinformation is a massive problem to tackle. KFF (the Kaiser Family Foundation) is a U.S. nonprofit focused on health policy research. It polled 1,519 U.S. adults in October and found that 78 percent of respondents believe, or are “uncertain” whether or not to believe, at least one of eight common myths about COVID-19. For example, 35 percent believed or were “uncertain” about whether the government is hiding vaccine-related deaths, and 28 percent thought ivermectin was or might be a “safe and effective treatment” for the disease.

The misconceptions correlate with likelihood to get vaccinated: 64 percent of unvaccinated respondents believed, or were uncertain about, at least four of the falsehoods. Only 19 percent of vaccinated adults said the same.

Part of the battle against misinformation is ensuring that good information is available to those who are looking for it. The county launched a COVID-19 misinformation explainer site, while staff address resident questions and provide information at public events, Nathan Fletcher, chair of the San Diego County Board of Supervisors, told Government Technology.

Cities like Oceanside have been taking advantage of the new resources. Oceanside Management Analyst Terry Gorman Brown, who also handles the city’s communications, said she uses San Diego County’s explainer site to help answer resident and staff questions. Brown said she also links to it in the city’s monthly e-newsletter.

Trusted Voices

San Diego County works to avoid accidentally amplifying misinformation. A panel of doctors gather after every Board of Supervisors meeting to address and correct any misconceptions that arose during discussions, Fletcher said. The doctors’ conversations are broadcasted on local TV and social media.

“People turn to those they trust, and so we want to give people an alternative to taking their health advice from what their uncle posts on his Facebook page,” Fletcher said.

National City Mayor Alejandra Sotelo-Solis said it’s helpful to have such timely, to-the-point fact checking.

Fletcher said the county makes a point to call on local medical professionals, as residents are likely to already know and trust them, he said.

Brown spoke similarly: “They recognize the medical director at Sharp or the medical director at Scripps speaking to them, telling them what they’re seeing at the hospital.”

Combating misinformation effectively relies on being open with the public about what we know and don’t know, said Christian Ramers, an infectious disease specialist who participates in the doctors’ panels.

Scientific knowledge grows slowly and gradually as tests are conducted and findings verified. Being clear about unknowns helps prevent people from filling those knowledge gaps with misinformation, Ramers told GovTech.

“Misinformation just travels so quickly — and way faster than the pace of scientific discovery, which, to be frank, is slow and kind of happens in fits and starts,” Ramers said.

What’s the Impact?

At this point, many of the people who have chosen to avoid vaccinations may be difficult to sway.

“Two years in [during the pandemic], people have taken a stance one way or the other,” Brown said.

It’s hard to measure the explainer site’s impact on residents, she said, but any points the initiative manages to score against misinformation means fewer deaths and hospitalizations.

There are signs of improvement. Fletcher said he’s noticed “fewer instances of blatant misinformation” at Board of Supervisor meetings since the initiative debuted.

Ramers called the fight against misinformation a “whack-a-mole situation,” where new fake treatments and rumors emerge even as the last ones are dispelled. Even so, he continues to see “small victories” in which patients with strong anti-vaccine views come to realize their concerns aren’t supported by evidence.

Medical, City Efforts

There’s only so much a county can achieve alone. Fletcher said he hopes the combined misinformation-fighting efforts from various cities and counties will turn the tide.

Other agencies and organizations have developed their own efforts. For example, Ramers said the nonprofit San Diego County Medical Society has been holding regular town halls to keep physicians aware of the latest COVID-19 updates.

Sotelo-Solis has also sought to reach residents by striving to find — and be — a trusted local messenger about vaccines. Her city is home to many essential workers and has been hard hit by the pandemic. Last month, National City had one of the highest rates of COVID-19 cases per 100,000 residents among municipalities in San Diego County.

Sotelo-Solis participated in Johnson & Johnson’s vaccine trial in 2020. So that residents would know what to expect, she showed on video her experience with nasal swabs and other testing and discussed the side effects she felt. She also explained where she personally turned to for COVID-19 information.

“I did that to help dispel those myths and misinformation that was going out about vaccines,” Sotelo-Solis said. “I really tried to shed light on, one, what it was to be part of a vaccine trial — because that was my first ever — but also, as a Latina, as a mom, as a working parent, as someone from a working-class community, to let people peak behind the curtain.”

The city also tapped well-known community figures to help share information, she said.

“In the promotora model — which works — you get one trusted señora or the elder in the community, and they will help spread that message,” she said.

In partnership with the county, the city also asked members of nonprofits that provide food and housing support to share testing and vaccine information in their daily interactions with people.

Fighting misinformation also requires using the right languages and a variety of communication channels. Texting and in-person conversations can reach residents who may be experiencing Internet fatigue or who may lack reliable broadband.

According to Sotelo-Solis, any messaging needs to be repeated to be effective.

“Like with anything, it has to be in their faces at least eight times for it to stick,” she remarked.

California Asks, Are Medical Falsehoods Malpractice?

State legislators have proposed a bill that would make it easier for the state medical board to penalize doctors for spreading COVID-19 misinformation. The board can already discipline doctors for misconduct.

Sotelo-Solis and Ramers both supported the bill. Sotelo-Solis recounted that a nurse recently seemed reluctant to let her sister know how to get a booster, and that such resistance could dissuade or confuse someone who is on the fence or communicating across a language barrier.

Ramers said he is “peripherally consulting” on a legal case against a California doctor whose patient got COVID-19 and died after following debunked advice. The patient was a woman in her 30s with obesity, but the doctor allegedly recommended against vaccination or monoclonal antibody treatments and instead pushed taking hydroxychloroquine, which is known to be ineffective against COVID-19.

“It’s not just a theoretical thing. There are actually people dying because of physicians that are practicing well below the standard of care,” Ramers said. “This isn’t just political dialogue in the public square.”

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